manifesto for community rehabilitation

| Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK | | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK |

OUR CALL: EQUAL ACCESS TO HIGH QUALITY, PERSON CENTRED, COMMUNITY REHABILITATION

As a collective of organisations we stand ready to work with you to deliver effective, person-centred community rehabilitation services to all those who need them so that people can live well longer.

We call on candidates to take these three steps:• Make a commitment to community rehabilitation in your party’s policies

• Mandate NHS England to improve the quality and accessibility of community rehabilitation services

• Amend the NHS Constitution to make people’s existing rights to community rehabilitation clearer and more explicit.

What do we mean by a ‘right to community rehabilitation’?We define community rehabilitation as the provision of assessment, advice and tailored rehabilitation support to improve people’s health and wellbeing, outside of acute hospital wards. Everybody should have access to high quality, personalised community rehabilitation - when they need it. This can be support because of a long-term condition, following an injury or to be in the best shape possible for a medical intervention. But, there are significant gaps in provision:

• Only 15% of people with lung disease deemed eligible for pulmonary rehabilitation are referred for it (1)

• Only half of people can access cardiac rehabilitation after a cardiac event, and this rate is even lower for women, BME and economically deprived patients (2)

| Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK | | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK | | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy

• After a hip fracture operation only one in five services provide people with rehabilitation on discharge from hospital, despite evidence that this is what best aids recovery(3)

• Falls prevention services are a postcode lottery if everywhere provided high quality falls prevention support, 29,000 injuries due to falls in older people could be prevented every year(4)

• 44% of people with neurological conditions don’t have access to community rehabilitation for their condition: 22% would like psychological therapy and 13% would like physiotherapy but can’t get it (5)

• Most people with a cancer diagnosis are not given support before treatment to improve their fitness levels, diet and mental health – in spite of strong evidence that this improves treatment outcomes(6)

• Of the 1.3 million people living with traumatic brain injury, only 40% receive neuro rehabilitation.(7)

If people can access private community rehabilitation, then they do so. But not everyone has this option. This falls short of the NHS Constitution. The NHS Constitution for England pledges to provide a comprehensive health care system to; meet individuals’ needs; prevent and improve mental and physical health problems; promote equality and for this to be universal and free of charge.

While community rehabilitation provision is patchy, the system is neither comprehensive nor universal. This fuels health inequalities – contributing to the fact that levels of ongoing ill health and disability are greater in areas of deprivation.(8)

There have been great medical advances in recent decades. Many more people now survive illness and injury that would previously have killed them. For example, deaths from stroke have halved over the last decade.(9) The challenge for the government and the NHS now is to ensure people can live well for longer. The NHS Long Term Plan sets this goal. Comprehensive high quality community rehabiltiation is the way to achieve it. The UK is in the bottom half of OECD countries when it comes to the proportion of our

health spending invested in meeting long-term health needs.(10) Existing NHS resources need to be aligned behind comprehensive community rehabilitation options.

Why is community rehabilitation important?• Long-term conditions, illness and injury can ruin people’s lives and take away their independence. Rehabilitation enables people to achieve their potential and provides support for us all to live as well as possible

• Community rehabilitation reduces demand on the most expensive parts of the NHS. Most emergency admissions are of people with long term health conditions,

| British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK | | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish

increasingly more than one.(11) Making community rehabilitation available to people before they are in crisis cuts demands on emergency care

• Rehabilitation for people with heart diseases reduces risk of dying prematurely from a cardiovascular event by 26% ,(12) reduces unplanned readmissions by 18%,(12)

and reduces all-cause mortality by 13%.(13) If just 65% of the people eligible for cardiac rehabilitation received it, the saving to NHS could be £30 million per year(14)

• People with traumatic brain injuries who receive rehabilitation once they have left an acute hospital ward cost the NHS and social care £27,800 less a year than those who don’t (15)

• Chronic obstructive pulmonary disease (COPD) costs the NHS £800 million per year and is the 2nd largest cause of emergency admissions.(16) If everyone eligible for pulmonary rehabilitation received it, emergency admissions would be cut by 13% (16)

• Falls are the largest cause of emergency hospital admissions for older people, (17) as well as the 6th largest cause of disability.(8) Falls prevention services reduce serious falls among older people by 24%. We could save £59 million in emergency admissions if these were universal. (18)

Community rehabilitation reduces reliance on a struggling social care system • Following hip fracture operations, 90% of patients will need support from social care. (19) Timely access to community rehabilitation reduces the number of people who need social care

• Each hip fracture costs £8,237 in social care and £9,739 in hospital care. Fracture liaison services are a proven model of community rehabiltiation that, if universal, would save £400 million from social care and NHS budgets(20)

• A young person with a brain haemorrhage normally moves on from an acute hospital ward to an older person’s care home for life. If, instead, they moved to a neuro centre for rehabilitation, within 5 years they could be living independently. Over the course of a lifetime, this saves £2 million from social care and NHS budgets(21)

• For sight impaired people, vision rehabilitation saves £3 for every £1 spent by the NHS and social care.(22)

Improving access to community rehabilitation services reduces inequality • Many people pay for community rehabilitation to support their recovery or to manage their condition because they can’t get what they need from the healthcare system. But many people cannot afford to and they shouldn’t have to

| Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK | | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy UK | Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy | Macmillan Cancer Support|The Neurological Alliance|Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists | Royal College of Speech and Language Therapy|Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK|Age UK | Arthritis and Musculoskeletal Alliance | The Association of Chartered Physiotherapists in Cardiovascular Rehabilitation | Association of Chartered Physiotherapists in Respiratory Care | British Heart Foundation | British Lung Foundation | British and Irish Orthoptic Society | British Society of Rehabilitation Medicine | Chartered Society of Physiotherapy |Macmillan Cancer Support | The Neurological Alliance | Rehabilitation Workers Professional Network | British Association of Cardiovascular Prevention and Rehabilitation | Royal College of Occupational Therapists|Royal College of Speech and Language Therapy | Royal Osteoporosis Society | Sue Ryder | UK Acquired Brain Injury Forum | Vision UK | | Spinal Injuries Association | Versus Arthritis | Muscular Dystrophy

• Often what is offered to people is not timely or suitable to meet their needs – for example if they work, or have more than one condition

• Driving improvements so that everyone has access to the best rehabilitation option for them will improve our public health and wellbeing, and reduce inequalities in health and other areas.

Rehabilitation must change and innovate to help us all live well longer To meet modern population needs, services need to:

• Be fully accessible, helping people overcome any barriers they face

• Be truly person-centred, tailored to meet individuals’ various needs, rather than by single conditions

• Embrace social prescribing and be networked with existing sports, leisure and voluntary sector activities.

• Harness new technology.

How can you help? Make a commitment to high quality, accessible community rehabilitation by encouraging your party to: - Use the NHS Accountability Framework to mandate NHS England to use promised increases in funding to deliver this.

- Amend the NHS Constitution to make people’s existing rights to community rehabilitation clearer and more explicit, as a key part of a comprehensive health care system.

December 2019

References1. Royal College of Physicians, British Thoracic Society. Pulmonary rehabilitation: steps to breathe better. London: Royal College of Physicians; 2016. 2. British Heart Foundation. National Audit of Cardiac Rehabilitation (NACR) Quality and Outcomes Report 2018. London: British Heart Foundation; 2018. 3. Royal College of Physicians. Recovering after a hip fracture: helping people understand physiotherapy in the NHS. London: Royal College of Physicians; 2018. 4. NHS Right Care. NHS RightCare: Frailty Toolkit: optimising a frailty system. London: NHS Right Care; 2019. 5. Neurological Alliance. Neuro Patience: still waiting for improvements in treatment and care. London: Neurological Alliance; 2019. 6. Macmillan Cancer Support. Prehabilitation for People with Cancer. London: Macmillan Cancer Support; 2019. 7. United Kingdom Brain Injury Forum. Acquired brain injury and neurorehabilitation: time for change. London: United Kingdom Brain Injury Forum; 2018. 8. Vos T, Barber RM, Bell B, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015;386(9995):743-800. 9. Seminog OO, Scarborough P, Wright FL, et al. Determinants of the decline in mortality from acute stroke in England: linked national database study of 795 869 adults. Bmj. 2019;365:l1778.URL: 10. Organisation for Economic Co-operation and Development. Health at a Glance 2017. Paris: OECD Publishing; 2017. 11. Deeny S, Thorlby R, Steventon A. Briefing: Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions. London: Health Foundation; 2018. 12. Anderson L, Oldridge N, Thompson DR, et al. Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2016;67(1):1-12. 13. Heran BS, Chen JM, Ebrahim S, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011(7):CD001800. 14. NHS Improvement. Making the case for cardiac rehabilitation: modelling potential impact on readmissions. London: NHS Improvement; 2013. 15. National Clinical Audit of Specialist Rehabilitation following Major Injury (NCASRI) Project Operational Team. Specialist rehabilitation for patients with complex needs following major injury: clinical audit. London: Healthcare Quality Improvement Partnership; 2016. 16. The Chartered Society of Physiotherapy. COPD Prime Tool London: The Chartered Society of Physiotherapy; 2017. 17. Association of Public Health Observatories. Commonly used public health statistics and their confidence intervals. London: Association of Public Health Observatories; 2008. 18. National Osteoporosis Society, NHS Right Care, Public Health England. RightCare Pathway: falls and fragility fractures. London: NHS Right Care 2013. 19. Public Health England. Falls and fracture consensus statement: supporting commissioning for prevention London: Public Health England; 2017. 20. Royal Osteoporosis Society. Fracture Liaison Service Benefits Calculator. 2015. 21. Sue Ryder. The case for proactive neurological care. London: Sue Ryder; 2018. 22. Ronca M, Peach B, Thompson I, et al. Demonstrating the impact and value of vision rehabilitation. London: OPM Group; 2017.

Who are we?We are a collective of 20 charities, trade unions and professional bodies coming together to call on all political parties to ensure there is equal access to high quality community rehabilitation services for all.

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